Registration Form - Highway City Community Development

REGISTRATION ENDS MARCH 28th

Breakaway Registration

* Indicates required field

Parent or Guardian Name *

First

Last

Contact Number *

Email *

Child 1

Name *

First

Last

Choose One *

Male Female

Age *

Grade *

Allergies or medical conditions *

Child 2

Name *

First

Last

Choose One *

Male Female

Age *

Grade *

Allergies or medical conditions *

Child 3

Name *

First

Last

Choose One *

Male Female

Age *

Grade *

Allergies or medical conditions *

By clicking yes, you are agreeing that your child or children may participate at the "Breakout" event at the (Granville Teague Community Center). And that HCCD is not liable for any injury(s) that my occur during this event.

I Agree *

Yes No

Submit